Diabetes mellitus, a state of low bone turnover: a systematic review and meta-analysis

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Hygum, Katrine¹; Starup-Linde, Jakob^1,2; Harsløf1, Torben¹; Vestergaard, Peter³; Langdahl, Bente L.¹

Diabetes mellitus, a state of low bone turnover: a systematic review and meta-analysis

Eur J Endocrinol. March 2017;176(3):R137-R157

©2017 European Society of Endocrinology

Affiliations

¹Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark

²Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark

³Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Abstract

Objective: To investigate the differences in bone turnover between diabetic patients and controls.

Design: A systematic review and meta-analysis.

Methods: A literature search was conducted using the databases Medline at PubMed and EMBASE. The free text search terms ‘diabetes mellitus’ and ‘bone turnover’, ‘sclerostin’, ‘RANKL’, ‘osteoprotegerin’, ‘tartrate-resistant acid’ and ‘TRAP’ were used. Studies were eligible if they investigated bone turnover markers in patients with diabetes compared with controls. Data were extracted by two reviewers.

Results: A total of 2881 papers were identified of which 66 studies were included. Serum levels of the bone resorption marker C-terminal cross-linked telopeptide (−0.10 ng/mL (−0.12, −0.08)) and the bone formation markers osteocalcin (−2.51 ng/mL (−3.01, −2.01)) and procollagen type 1 amino terminal propeptide (−10.80 ng/mL (−12.83, −8.77)) were all lower in patients with diabetes compared with controls. Furthermore, s-tartrate-resistant acid phosphatase was decreased in patients with type 2 diabetes (−0.31 U/L (−0.56, −0.05)) compared with controls. S-sclerostin was significantly higher in patients with type 2 diabetes (14.92 pmol/L (3.12, 26.72)) and patients with type 1 diabetes (3.24 pmol/L (1.52, 4.96)) compared with controls. Also, s-osteoprotegerin was increased among patients with diabetes compared with controls (2.67 pmol/L (0.21, 5.14)).

Conclusions: Markers of both bone formation and bone resorption are decreased in patients with diabetes. This suggests that diabetes mellitus is a state of low bone turnover, which in turn may lead to more fragile bone. Altered levels of sclerostin and osteoprotegerin may be responsible for this
Links

DOI: 10.1530/EJE-16-0652

PubMed: 28049653

WoS: 000395897500005
History

Received: 2016-08-03

Revised: 2016-10-31

Accepted: 2016-11-15

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2021	Park HY, Han K, Kim Y, Kim YH, Sur YJ. The risk of hip fractures in individuals over 50 years old with prediabetes and type 2 diabetes: a longitudinal nationwide population-based study. Bone. January 2021;142:115691.
2021	Hu P, McKenzie JA, Buettmann EG, Migotsky N, Gardner MJ, Silva MJ. Type 1 diabetic Akita mice have low bone mass and impaired fracture healing. Bone. June 2021;147:115906.
2022	Damrath JG, Metzger CE, Allen MR, Wallace JM. A novel murine model of combined insulin-dependent diabetes and chronic kidney disease has greater skeletal detriments than either disease individually. Bone. December 2022;165:116559.
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2020	Taylor EA. Validation and Implementation of Vibrational Spectroscopic Measures of Bone Composition [PhD thesis]. Ithaca, NY: Cornell University; December 2020.
2021	Sacher S. Characterization of Trabecular Morphology, Microdamage Accumulation, and Collagen Crosslinking in Bone Tissue from Individuals With Type II Diabetes Mellitus [Master's thesis]. Ithaca, NY: Cornell University; May 2021.
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